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Athlete's Foot

Topic Overview

What is athlete's foot?

Athlete's foot is a rash
on the skin of the foot. It is the most common
fungal skin infection. There are three main types of
athlete's foot. Each type affects different parts of the foot and may look
different.

What causes athlete's foot?

Athlete's foot is
caused by a
fungus that grows on or in the top layer of skin.
Fungi (plural of fungus) grow best in warm, wet places, such as the area
between the toes.

Athlete's foot spreads easily. You can get it
by touching the toes or feet of a person who has it. But most often, people get
it by walking barefoot on contaminated surfaces near swimming pools or in
locker rooms. The fungi then grow in your shoes, especially if your shoes are
so tight that air cannot move around your feet.

If you touch
something that has fungi on it, you can spread athlete's foot to other
people-even if you don't get the infection yourself. Some people are more
likely than others to get athlete's foot. Experts don't know why this is. After
you have had athlete's foot, you are more likely to get it again.

What are the symptoms?

Athlete's foot can make
your feet and the skin between your toes burn and itch. The skin may peel and
crack. Your symptoms can depend on the type of athlete's foot you have.

Toe web infection
usually occurs between the fourth and fifth toes. The skin becomes scaly,
peels, and cracks. Some people also may have an infection with bacteria. This
can make the skin break down even more.

Moccasin type infection may start with a little soreness on
your foot. Then the skin on the bottom or heel of your foot can become thick
and crack. In bad cases, the toenails get infected and can thicken, crumble,
and even fall out. Fungal infection in toenails needs separate
treatment.

Vesicular type infection usually
begins with a sudden outbreak of fluid-filled blisters under the skin.
The blisters are usually on the bottom of the foot. But they can appear
anywhere on your foot. You also can get a bacterial infection with this type of
athlete's foot.

How is athlete's foot diagnosed?

Most of the time,
a doctor can tell that you have athlete's foot by looking at your feet. He or
she will also ask about your symptoms and any past fungal infections you may
have had. If your athlete's foot looks unusual, or if treatment did not help
you before, your doctor may take a skin or nail sample to test for
fungi.

Not all skin problems on the foot are athlete's foot. If
you think you have athlete's foot but have never had it before, it's a good
idea to have your doctor look at it.

How is it treated?

You can treat most cases of
athlete's foot at home with over-the-counter lotion, cream, or spray. For bad
cases, your doctor may give you a prescription for pills or for medicine you
put on your skin. Use the medicine for as long as your doctor tells you to.
This will help make sure that you get rid of the infection. You also need to
keep your feet clean and dry. Fungi need wet, warm places to grow.

You can do some things so you don't get athlete's foot again. Wear shower
sandals in shared areas like locker rooms, and use talcum powder to help keep
your feet dry. Wear sandals or roomy shoes made of materials that allow
moisture to escape.

Cause

Athlete's foot
(tinea pedis) is a
fungal infection of the skin of the foot. You get athlete's foot when you come in contact with the
fungus and it begins to grow on your skin.

Fungi commonly grow on or in the top
layer of human skin and may or may not cause infections. Fungi grow best in
warm, moist areas, such as the area between the toes.

Athlete's
foot is easily spread (contagious). You can get it by touching the affected area
of a person who has it. More commonly, you pick up the fungi from damp,
contaminated surfaces, such as the floors in public showers or locker
rooms.

Although athlete's foot is contagious, some people are more
likely to get it (susceptible) than others.
Susceptibility may increase with age. Experts don't know why some people are
more likely to get it. After you have had athlete's foot, you are more likely
to get it again.

If you come in contact with the fungi that cause
athlete's foot, you can spread the fungi to others, whether you get the
infection or not.

Symptoms

Athlete's foot
(tinea pedis) symptoms vary from person to person. Although some people have
severe discomfort, others have few or no symptoms. Common symptoms
include:

Peeling, cracking, and scaling of the
feet.

Redness, blisters, or softening and breaking down
(maceration) of the skin.

Itching, burning, or both.

Toe web infection

Toe web infection (interdigital) is the most common
type of athlete's foot. It usually occurs between the two smallest toes. This
type of infection:

Often begins with skin that seems soft and
moist and pale white.

May cause itching, burning, and a slight
odor.

May get worse. The skin between the toes becomes scaly,
peels, and cracks. If the infection becomes severe, a bacterial infection is
usually present, which causes further skin breakdown and a foul odor.

Moccasin-type infection

Progresses to thickened, scaling,
cracked, and peeling skin on the sole or heel. In severe cases, the toenails
become infected and can thicken, crumble, and even fall out. For more
information, see the topic
Fungal Nail Infections.

May appear on the
palm of the hand (symptoms commonly affect one hand and both feet).

Vesicular infection

Usually begins with a sudden outbreak of fluid-filled blisters under the skin. The blisters most often develop on the skin
of the instep but may also develop between the toes, on the heel, or on the
sole or top of the foot.

Sometimes occurs again after the
first infection. Infections may occur in the same area or in another area
such as the arms, chest, or fingers. You may have scaly skin between eruptions.

May also be accompanied by a bacterial infection.

Athlete's foot is sometimes confused with pitted
keratolysis. In this health problem, the skin looks like a "moist honeycomb."
It most often occurs where the foot carries weight, such as on the heel and the
ball of the foot. Symptoms include feet that are very sweaty and smell
bad.

What Happens

How
athlete's foot (tinea pedis) develops and how well it
responds to treatment depends on the type of athlete's foot you have.

Toe web infection

Toe web infections (interdigital) often begin with skin that seems moist and
pale white. You may notice itching, burning, and a slight odor. As the
infection gets worse, the skin between the toes becomes scaly, peels, and
cracks. If the fungal infection becomes severe, a bacterial infection also may
develop. This can cause further skin breakdown. The bacterial infection may
also infect the lower leg (cellulitis of the lower leg). Toe web infections
often result in a sudden vesicular (blister) infection.

Toe web
infections respond well to treatment.

Moccasin-type infection

Moccasin-type infections
may begin with minor irritation, dryness, itching, burning, or scaly skin and
progress to thickened, cracked skin on the sole or heel. In severe cases, the
toenails become infected and can thicken, crumble, and even fall out. If you do
not take preventive measures, this infection often returns. You may also
develop an infection on the palm of the hand (symptoms commonly affect one hand
and both feet).

Moccasin-type infections may be long-lasting.

Vesicular infection

Vesicular infections
(blisters) usually begin with a sudden outbreak of blisters that become red and
inflamed. Blisters sometimes erupt again after the first infection. A
bacterial infection may also be present. A vesicular infection often develops
from a long-lasting toe web infection. Blisters may also appear on palms, the
side of the fingers, and other areas (dermatophytid or id reaction).

Vesicular infections usually respond well to treatment.

Complications

If untreated, skin blisters and
cracks caused by athlete's foot can lead to severe bacterial infections. In
some types of athlete's foot, the toenails may be infected. For more
information, see the topic
Fungal Nail Infections.

All types of athlete's foot can be treated, but
symptoms often return after treatment. Athlete's foot is most likely to return
if:

You don't take preventive measures and are
again exposed to fungi that cause athlete's foot.

You don't use
antifungal medicine for the prescribed length of time and the fungi are not
completely killed.

The fungi are not completely killed even after
the full course of medicine.

Severe infections that appear suddenly, and keep returning,
can lead to long-lasting infection.

What Increases Your Risk

Athlete's foot is easily
spread (contagious). You can get it by touching the affected area of a person
who has it. More commonly, you pick up the fungi from damp, contaminated
surfaces, such as the floors in public showers or locker rooms.

Athlete's foot is contagious, but some people are more likely to get
it (susceptible) than others.
Susceptibility may increase with age. Experts don't know why some people are
more likely to get it. After you have had athlete's foot, you are more likely
to get it again.

If you aren't susceptible to athlete's foot, you
may come in contact with the
fungi that cause athlete's foot yet not get an
infection. But you can still spread the fungi to others.

Aging. Athlete's foot is more common in older adults.
Children rarely get it.

Risk factors you can change

Risk factors you can
change include:

Allowing your feet to remain
damp.

Wearing tight, poorly ventilated shoes.

Using
public or shared showers or locker rooms without wearing shower
shoes.

Doing activities that involve being in the water for long
periods of time.

When To Call a Doctor

Call your doctor about a skin
infection on your feet if:

Your feet have severe cracking, scaling, or
peeling skin.

You have blisters on your feet.

You
notice signs of bacterial infection, including:

Increased pain, swelling, redness,
tenderness, or heat.

Red streaks extending from the affected
area.

Discharge of pus.

Fever of
100.4°F (38°C) or higher with
no other cause.

The infection appears to be
spreading.

You have
diabetes or diseases associated with poor circulation
and you get
athlete's foot. People who have diabetes are at increased
risk of a severe bacterial infection of the foot and leg if they have athlete's
foot.

Your symptoms do not improve after 2 weeks of treatment or
are not gone after 4 weeks of treatment with a nonprescription antifungal
medicine.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. You can usually treat athlete's foot yourself at home. But
any persistent, severe, or recurrent infections should be evaluated by your
doctor.

When athlete's foot symptoms appear, you can first use a
nonprescription product. If your symptoms do not improve after 2 weeks of
treatment or have not gone away after 4 weeks of treatment, call your
doctor.

Who to see

Health professionals who can diagnose or treat
athlete's foot include:

Exams and Tests

In most cases, your doctor can
diagnose
athlete's foot (tinea pedis) by looking at your foot.
He or she will also ask about your symptoms and any previous
fungal infections you have had.

If your
symptoms look unusual or if a previous infection has not responded well to
treatment, your doctor may collect a skin or nail sample by lightly scratching
the skin with a blade or the edge of a microscope slide, or by trimming a nail.
He or she will examine the skin and nail samples using laboratory tests
including:

In rare cases, a
skin biopsy will be done by removing a small piece of
skin that will be looked at under a microscope.

Treatment Overview

How you treat
athlete's foot (tinea pedis) depends on its type and
severity. Most cases of athlete's foot can be treated at home using an
antifungal medicine to kill the
fungus or slow its growth.

Nonprescription antifungals usually are
used first. These include clotrimazole (Lotrimin), miconazole (Micatin),
terbinafine (Lamisil), and tolnaftate (Tinactin). Nonprescription
antifungals are applied to the skin (topical medicines).

Prescription antifungals may be tried if nonprescription
medicines are not successful or if you have a severe infection. Some of these
medicines are
topical antifungals, which are put directly on the
skin. Examples include butenafine (Mentax), clotrimazole, and naftifine (Naftin). Prescription antifungals can also
be taken as a pill, which are called
oral antifungals. Examples of oral antifungals include fluconazole (Diflucan), itraconazole (Sporanox), and terbinafine (Lamisil).

For severe athlete's foot that doesn't improve, your doctor
may prescribe oral antifungal medicine (pills). Oral antifungal pills are used
only for severe cases, because they are expensive and require periodic testing
for dangerous
side effects. Athlete's foot can return even after antifungal pill
treatment.

Even if your symptoms improve or stop shortly
after you begin using antifungal medicine, it is important that you complete the full
course of medicine. This increases the chance that athlete's foot will not
return. Reinfection is common, and athlete's foot needs to be fully treated
each time symptoms develop.

Toe web infections

Toe web (interdigital)
infections occur between the toes, especially between the fourth and fifth
toes. This is the most common type of athlete's foot infection.

If a severe infection develops, your doctor may prescribe
a combination of topical antifungal creams plus either oral or topical
antibiotic medicines.

Moccasin-type infections

Moccasin-type athlete's foot causes scaly, thickened
skin on the sole and heel of the foot. Often the toenails become infected
(onychomycosis). A moccasin-type infection can be more difficult
to treat, because the skin on the sole of the foot is very thick.

Nonprescription medicines may not penetrate
the thick skin of the sole well enough to cure moccasin-type athlete's foot. In
this case, a prescription topical antifungal medicine that penetrates the sole,
such as ketoconazole, may be used.

Vesicular infections

Vesicular infections, or blisters, usually appear on
the foot instep but can also develop between the toes, on the sole of the foot,
on the top of the foot, or on the heel. This type of fungal infection may be
accompanied by a bacterial infection. This is the least common type of
infection.

Treatment of vesicular infections may be done at your
doctor's office or at home.

You can dry out the blisters at home by soaking your foot in
nonprescription
Burow's solution several times a day for 3 or more
days until the blister area is dried out. After the area is dried out, use a
topical antifungal cream as directed. You can also apply compresses using
Burow's solution.

If you also have a bacterial infection, you will
most likely need an oral
antibiotic.

Even when treated, athlete's foot often returns.
This is likely to happen if:

You don't take preventive measures and are
again exposed to the fungi that cause athlete's foot.

You don't use
antifungal medicine for the specified length of time and the fungi are not
completely killed.

The fungi are not completely killed even after
the full course of medicine.

You can prevent athlete's foot by:

Keeping your feet clean and dry.

Dry between your toes after swimming or
bathing.

Wear shoes or sandals that allow your feet to
breathe.

When indoors, wear socks without shoes.

Wear
socks to absorb sweat. Change your socks twice a day.

Use talcum or
antifungal powder on your feet.

Allow your shoes to air for at
least 24 hours before you wear them again.

Wearing shower sandals in public pools and
showers.

What to think about

You may choose not to treat
athlete's foot if your symptoms don't bother you and you have no health
problems that increase your chance of severe foot infection, such as
diabetes. But untreated athlete's foot that causes
skin blisters or cracks can lead to severe bacterial infection. Also, if you
don't treat athlete's foot, you can spread it to other people.

Severe infections that appear suddenly (acute) usually respond well to
treatment. Long-lasting (chronic) infections can be more difficult to
cure.

Toenail infections (onychomycosis) that can develop with
athlete's foot tend to be more difficult to cure than fungal skin infections.
For more information, see the topic
Fungal Nail Infections.

Prevention

You can prevent
athlete's foot (tinea pedis) by:

Keeping your feet clean and dry.

Dry between your toes after swimming or
bathing.

Wear shoes or sandals that allow your feet to
breathe.

When indoors, wear socks without shoes.

Wear
socks to absorb sweat. Change your socks twice a day.

Use talcum or
antifungal powder on your feet.

Allow your shoes to air for at
least 24 hours before you wear them again.

Wearing shower sandals in public pools and
showers.

If you have athlete's foot, dry your groin area before your
feet after bathing. Also, put on your socks before your underwear. This can
prevent fungi from spreading from your feet to your groin, which may cause
jock itch. For more information about jock itch, see the topic
Ringworm of the Skin.

Tips to prevent athlete's foot recurrence

Always finish the full course of any antifungal
medicine (cream or pills). Live fungi remain on your skin for days after your
symptoms have disappeared. The chances of killing athlete's foot are greatest
when you treat it for the prescribed period of time.

Washing
clothes in soapy, warm water may not kill the fungi that cause athlete's foot.
Use hot water and bleach to increase the chance of killing fungi on your
clothes.

You can help prevent recurrence of a
toe web infection by using powder to keep your feet dry, using lamb's wool
between the toes (to separate them), and wearing wider, roomier shoes that have
not been infected by fungi. Lamb's wool is available at most pharmacies or foot
care stores.

Home Treatment

You can usually treat
athlete's foot (tinea pedis) yourself at home by using
nonprescription medicines and taking care of your feet. But if you have
diabetes and develop athlete's foot, or have
persistent, severe, or recurrent infections, see your doctor.

Nonprescription medicines

Nonprescription antifungals include clotrimazole (Lotrimin), miconazole (Micatin),
terbinafine (Lamisil), and tolnaftate (Tinactin). These medicines are
creams, lotions, solutions, gels, sprays, ointments, swabs, or powders that are
applied to the skin (topical medicine). Treatment will last from 1 to 6
weeks.

If you have a vesicular (blister) infection, soak your foot
in
Burow's solution several times a day for 3 or more
days until the blister fluid is gone. After the fluid is gone, use an
antifungal cream as directed. You can also apply compresses using Burow's
solution.

To prevent athlete's foot from returning, use the full
course of all medicine as directed, even after symptoms have gone away.

Allow your shoes to air for at
least 24 hours before you wear them again.

Wear shower sandals in public pools and
showers.

If you have athlete's foot, dry your groin area before
your feet after bathing. Also, put on your socks before your underwear. This
can prevent fungi from spreading from your feet to your groin, which may cause
jock itch. For more information about jock itch, see the topic
Ringworm of the Skin.

You may choose not to treat athlete's foot if your
symptoms don't bother you and you have no health problems that increase your
risk of severe foot infection, such as
diabetes. But an untreated athlete's foot infection
causing skin blisters or cracks can lead to severe bacterial infection. Also,
if you don't treat athlete's foot infection, you can spread it to other
people.

Medications

Antifungal medicines that are used on the
skin (topical) are usually the first choice for treating
athlete's foot (tinea pedis). They are available in
prescription or nonprescription forms. Nonprescription medicines are usually
tried first.

For severe cases of athlete's foot, your doctor may
prescribe oral antifungals (pills). But treatment with this medicine is
expensive, requires periodic testing for dangerous
side effects, and does not guarantee a cure.

When you are treating
athlete's foot, it is important that you use the full course of the medicine. Using it as directed,
even after the symptoms go away, increases the likelihood that you will
kill the fungi and that the infection will not return.

Medicine choices

Prescription antifungals
may be tried if nonprescription medicines do not help or if you have a severe
infection. Some of these medicines are
topical antifungals, which are put directly on the
skin. Examples include butenafine (Mentax), clotrimazole, and naftifine (Naftin). Prescription antifungals can also
be taken as a pill, which are called
oral antifungals. Examples of oral antifungals include fluconazole (Diflucan),
itraconazole (Sporanox), and terbinafine (Lamisil).

What to think about

You may choose not to treat
athlete's foot if your symptoms don't bother you and you have no health
problems that increase your risk of severe foot infection, such as
diabetes. But an untreated athlete's foot infection
causing skin blisters or cracks can lead to severe bacterial infection. Also,
if you don't treat athlete's foot, you can spread it to other people.

If your symptoms do not improve after 2 weeks of treatment or have not
gone away after 4 weeks of treatment, call your doctor.

Some topical antifungal medicines work faster (1
to 2 weeks) than other topical medicines (4 to 8 weeks). All of the
faster-acting medicines have similar cure rates.footnote 1 The
fast-acting medicines may cost more than the slower-acting ones, but you use
less of these medicines to fully treat a fungal infection. Oral antifungal
medicines are typically taken for 2 to 8 weeks.

Other Treatment

Tea tree oil is an antifungal and
antibacterial agent derived from the Australian Melaleuca alternifolia tree. Although it reduces fungi and resulting symptoms, tea
tree oil may not completely kill off the infection.footnote 2

Ajoene is an antifungal compound found in garlic.
It is sometimes used to treat athlete's foot.

Compresses or foot
soaks using nonprescription Burow's solution can help soothe and dry out
blisterlike (vesicular) athlete's foot. After the blister fluid is gone, you
can use antifungal creams or prescription antifungal pills.

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NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer